Voluntary Euthanasia

[GARY_FL_NURSE]

I think one of the cruelest things we do is let patients lay in nursing home beds without the legal ability to terminate their own lives. I'd be interest in what other nurses think of this.

If you ask active people who are in their 40s and alert and you say to them "when you get older and you lose the capacity to know your surroundings and you no longer recognize your family members, and if you reach a point where someone has to change your brief in a bed or feed you your meals, would you prefer to live your life like that or would you prefer someone terminate your life painlessly and peacefully?"

What do you think most people's response would be???

Mine would be termination of my life! But guess what that is against the law in most states.

I'd be interested in knowing what other nurses think about this. We get trained over and over again about abuse. Well to me, the biggest abuse we commit is we do not allow Voluntary Euthanasia over laying in a soiled brief in a nursing home bed where we can't even feed ourselves anymore. Voluntary Euthanasia is illegal in all states and PAD is allowed only in Washington, Oregon, Montana, and Vermont.

[ComeTogether, LPN]

The title of the thread is "voluntary euthanasia"

That may very well be, but since "voluntary euthanasia" is an oxymoron, that's not what I took it to mean.

Giving consent ahead of time but not being able to consent at the time of, to me, would be euthanasia, so I think my brain just crossed out the "voluntary" part.

Anyways, I was just clarifying.

[ComeTogether, LPN]

It's not always different just because they are unable to eat. When a patient, or their decision maker' choses to allow an illness to naturally run it's course, an inability to eat is often a direct result of the illness and therefore artificial feeding isn't used.

I was referring to the placing of feeding tubes for patients who have lost the ability to eat/swallow being much different than placing a feeding tube in someone who is refusing to eat.

Obviously, if they have an advanced directive indicating they don't want a feeding tube, they shouldn't get one. I thought that was a given.

[toomuchbaloney]

=Glycerine82;8159527]I have no problem with that, my last fur baby died in my arms, I would have given the shot if I was allowed. I'd do it at home if I could get my hands on the meds involved.

I have a problem with the verb-age you're using. You never said you give your animal poison to humanely euthanize him/her. You said it the way you said it, so you could stir the pot.

You insinuated that to euthanize an animal is more for convenience than out of compassion.

To me, someone doesn't make comments like that unless they're trying to "stir the pot".

While you are welcome to your opinion, and I enjoy reading it, you are not entitled to assign intent to my posts without my permission.

You are quite correct that I am trying to be specific in my language. You consider it stirring the pot. I am challenging your comfort level and the comfort level of others reading this thread; intentionally. This is serious stuff right here and if one has no stomach to consider shooting a beloved pet at end of life then thinking about euthanizing a human seems a bit far fetched.

Killing is killing and dead is dead. Part of my lifestyle involves killing. I end lives on a regular basis because I am a meat eater. The vast majority of meat in my freezer was not purchased from a grocery store.

I am an advocate of quick and merciful deaths with respect for the life and the death. I am not interested, however, in participating in the active killing of a human. If they are seeking to avoid suffering we can most likely help them. If they want to die then they will have to find folks who are willing to help them with that, as I am not interested personally or professionally

No, I would not give my pet or my human loved one a "poison" to end their life. I avoid poisons at every opportunity. I have only a very few of them in my home, such as bleach. I prefer not to use poisons at all but quite a number are employed by physicians and pharmacists in their work, subsequently I am involved in their utilization as well.

It is troubling that we engage in things for convenience when it seems philosophically that, perhaps we shouldn't. It is both compassion and convenience which leads me to euthanize my own pets most of the time. I have utilized a veterinarian to euthanize a pet. I called on a Friday evening and had to wait until Monday before the guy could come to my home. The actual death was peaceful but the interim involved too much suffering.

If "stirring the pot" means making people think about the subject then that is my intent. If it means trying to make folks angry or upset...nope, not my intent. If the frank discussion of killing and death makes people uncomfortable then this is not the thread for them.

[toomuchbaloney]

I was referring to the placing of feeding tubes for patients who have lost the ability to eat/swallow being much different than placing a feeding tube in someone who is refusing to eat.

Obviously, if they have an advanced directive indicating they don't want a feeding tube, they shouldn't get one. I thought that was a given.

People at end of life often, perhaps even typically, refuse to eat. Most of them are quite able to eat, they simply no longer have desire.

[ComeTogether, LPN]

While you are welcome to your opinion, and I enjoy reading it, you are not entitled to assign intent to my posts without my permission.

You are quite correct that I am trying to be specific in my language. You consider it stirring the pot. I am challenging your comfort level and the comfort level of others reading this thread; intentionally. This is serious stuff right here and if one has no stomach to consider shooting a beloved pet at end of life then thinking about euthanizing a human seems a bit far fetched.

Killing is killing and dead is dead. Part of my lifestyle involves killing. I end lives on a regular basis because I am a meat eater. The vast majority of meat in my freezer was not purchased from a grocery store.

I am an advocate of quick and merciful deaths with respect for the life and the death. I am not interested, however, in participating in the active killing of a human. If they are seeking to avoid suffering we can most likely help them. If they want to die then they will have to find folks who are willing to help them with that, as I am not interested personally or professionally

No, I would not give my pet or my human loved one a "poison" to end their life. I avoid poisons at every opportunity. I have only a very few of them in my home, such as bleach. I prefer not to use poisons at all but quite a number are employed by physicians and pharmacists in their work, subsequently I am involved in their utilization as well.

It is troubling that we engage in things for convenience when it seems philosophically that, perhaps we shouldn't. It is both compassion and convenience which leads me to euthanize my own pets most of the time. I have utilized a veterinarian to euthanize a pet. I called on a Friday evening and had to wait until Monday before the guy could come to my home. The actual death was peaceful but the interim involved too much suffering.

If "stirring the pot" means making people think about the subject then that is my intent. If it means trying to make folks angry or upset...nope, not my intent. If the frank discussion of killing and death makes people uncomfortable then this is not the thread for them.

I did mean to throw in an IMO, but you're right, I shouldn't assume your intentions. I get what you're getting at.

[PomMom65]

Withdrawing care is much different than euthanasia.

[tyvin, BSN, RN]

I was referring to the placing of feeding tubes for patients who have lost the ability to eat/swallow being much different than placing a feeding tube in someone who is refusing to eat.

Obviously, if they have an advanced directive indicating they don't want a feeding tube, they shouldn't get one. I thought that was a given.

"I thought that was a given."

Don't be surprised when one day you are faced with the decision to institute NG tube orders on someone who is terminal and very close to death's door, whose advance directive clearly states no feeding tubes or NG tubes...that it's been discussed with family members, the doc, the RN and advance directives witnessed and signed and a family member made POA over medical decisions and all are in agreement. That the father lie in his bed, content that all would be fine and he could begin his journey to the other side, confident, that his family was in agreement with him.

This happened to me; as the father became less and less responsive with a terminal illness that is not kind and robs you of your ability and desire to walk, talk and eat, the family did something that shocked me. After their dad started to refuse to eat or in other words was at the phase in his illness where he had no desire or ability to eat, the family asked the doc to put a feeding tube in their father. What shocked me more was that the doc agreed to it!

The NG tube was ordered right there on my shift. After having a short and very tense conversation with the doctor and looking at the father...I refused to carry out the order. The doc went and wrote the order in the chart and left. I documented the whole thing and why I didn't institute the order. Though the father couldn't speak, his gestures and eyes told me everything I needed to know ... the tears from his eyes flowed over his cheekbones while I informed him of what they had decided to do.

I went into work the next day and got report that the father had got the NG tube placed last night but was taking it out and it was my turn to put it back in. I went into his room and held up the NG tube package and asked him if he wanted it. He shook his head as much as he was able to. I documented the whole disgusting business for the next 2 days as I would come on duty only to find out that the other nurses had been putting the NG tube back in him; only for him to pull it back out...none of them would listen to me and were more afraid of getting in trouble than honoring the father's requests.

Than I found out they were talking about instituting soft restraints so he couldn't tear the NG tube out. I could literally feel my heart break; my heart was breaking and I felt so desperately helpless.

I went into his room and told him what they were thinking of doing. I also told him I would do everything I could to not let it happen. I was imagining myself at his door warding off anyone trying to come in and place restraints on him. He looked at me and was able to squeeze my hand as he smiled up at me. I left to go call the doc. As I was sitting at the nurses station so spitting mad that the journey had taken such an ugly turn, a CNA came and told me that the father had stopped breathing. I went to his room and he had, in fact, passed.

It was one of many surreal moments in my nursing career. As I stood at the side of the father's bed, I realized tears were streaming down my face but I wasn't crying; I was celebrating his journey. He was able to go out the way that he wanted. I was crying for joy and that no one could touch him like they were.

We must defend the defenseless...I didn't get in trouble. No one ever talked to me about the whole thing. I quit shortly after that as my respect for my colleagues was gone. Another incident happened shortly after my guy passed.

The doctor who gave the NG tube order was the facilities medical director and I couldn't stomach him after that either. It just wasn't worth it...there was no trust or camaraderie. Sometimes I wonder if there ever was. I could no longer look at them and trust that they would have my back. At the beginning of my career I was sincerely disenchanted. The place was a very posh LTC facility that a famous religious organizations runs and owns, along with many other LTC facilities to help the elderly. Everyone had their own room, 44 bed facility, along with the Medicare all were private pay. That'll teach ya; you don't always get what you pay for

[suanna]

I have an idea- rather than deliberately taking action to cause a patients death- there are so many threads on AN about "Sub Par" practitioners of nursing care- maybe we can develope a new specialty- "Have you been told you are a crappy nurse, have you ever been asked to resign over skill issues- we have a job for you- Uncle Bobs marginal care hospice center"....

[hppygr8ful, ASN, RN, EMT-I]

I have an idea- rather than deliberately taking action to cause a patients death- there are so many threads on AN about "Sub Par" practitioners of nursing care- maybe we can develope a new specialty- "Have you been told you are a crappy nurse, have you ever been asked to resign over skill issues- we have a job for you- Uncle Bobs marginal care hospice center"....

I find your post very offensive to those of us who provide hospice care in the LTC setting. It's been my experience that Hospice especially when the patient comes in alert and oriented is essentially physician assisted Suicide. No it's not one shot and you are gone - but it provides comfort from pain and a chance for last moments with loved ones as they are eased on their journey towards death. Once hospice protocol is started I rarely see a patient go more than 3 weeks to 1 month. I used to see it differently until my dad was in the final stages of colon cancer and bone mets. We sat around his bed and shared a glass of good Irish Whiskey and talked until his final moment when he slipped off unto what was essentially a morphine overdose.

I have no regrets.

Hppy

[toomuchbaloney]

I find your post very offensive to those of us who provide hospice care in the LTC setting. It's been my experience that Hospice especially when the patient comes in alert and oriented is essentially physician assisted Suicide. No it's not one shot and you are gone - but it provides comfort from pain and a chance for last moments with loved ones as they are eased on their journey towards death. Once hospice protocol is started I rarely see a patient go more than 3 weeks to 1 month. I used to see it differently until my dad was in the final stages of colon cancer and bone mets. We sat around his bed and shared a glass of good Irish Whiskey and talked until his final moment when he slipped off unto what was essentially a morphine overdose.

I have no regrets.

Hppy

In your opinion it was a morphine overdose.

Sorry that your father died, glad he was able to receive palliation of his symptoms even though they obviously confused you.

[NRSKarenRN, BSN, RN]

International Association for Hospice & Palliative Care

The Double Effect of Pain Medication: Separating Myth from Reality

...Bonica found that with proper titration, clinically significant respiratory depression does not occur because pain is a powerful respiratory stimulant and counteracts the narcotic-induced depression."26 According to Cain and Hammes, the "feared shortening of life with side effects is not likely.`27 Inturrisi and Hanks found that opioids can be used without "significant risk."13 Portenoy noted that for cancer patients treated with chronic opioid therapy, serious respiratory compromise is "exceedingly rare.`28 And Cundiff reported that "with skillful management ... no evidence exists that [opioids] shorten life."29

Dahl, a pharmacologist, noted that "Respiratory depression is one of the most feared and misunderstood potential side effects of the opioids." Because pain is a stimulus to respiration, "clinically significant respiratory depression is rare."30 And, Berry, a pharmacist, found respiratory depression to be "an often stated but seldom observed side effect of opioid use." This is because pain is "nature's own antidote to respiratory depression."...

...BIOETHICAL DISCUSSIONS OF THE DOUBLE EFFECT

Relieving pain and providing comfort care is one of the primary duties of physicians and as such is a matter subject to ethical concern. Unfortunately, in ethical articles discussing end-of-life issues, any discussion of relieving pain is invariably followed, almost in the same breath, by a discussion of the double effect. Even when meant to encourage the use of opioids to relieve pain, these double effect discussions have the effect of reinforcing the misperception that cancer patients must die in pain unless medication that hastens death is administered. No data and little evidence can be found to support the notion that the use of medication to relieve pain is responsible for hastening the death of dying cancer patients. Yet, the ethical literature assumes it is a common occurrence. Few articles argue the point. It is just assumed to be true.

In their article, "The Physician's Responsibility Toward Hopelessly Ill Patients: A Second Look," Wanzer et al. urged the use of appropriate medication to better treat pain and stated that the "balance between minimizing pain and suffering and potentially hastening death should be struck clearly in favor of pain relief." Although these commentators made a very forceful argument for the need to increase the dosage of narcotics to whatever level is necessary to provide adequate pain relief, they still extended the myth that palliative care is often fatal because such action is ethical "even though the medication may contribute to the depression of respiration or blood pressure, the dulling of consciousness, or even death Ã’[emphasis added].4

It is often a nurse who must administer pain medication. In 1991, the American Nurses Association adopted a position statement on "Promotion of Comfort and Relief of Pain in Dying Patients":

Nurses should not hesitate to use full and effective doses of pain medication for the proper management of pain in the dying patient. The increasing titration of medication to achieve adequate symptom control, even at the expense of life, thus hastening death secondarily, is ethically justified.12

[42pines]

Voluntary euthanasia implies someone else ending the life. As the decades go by I suspect that various forms of self-controlled suicide will become more accepted from a societal and legal point of view.

A bit off topic, but of interest to those who find the subject matter interesting is the book "Still Alice" by Lisa Genova. It's a novel about a brilliant female psychologist who slowly develops early Alzheimers and decides that she wants to control the ending of her life.

I'll not go farther for fear of spoiling the story. I haven't read it but on goodreads.com and other places it is rated highly.